By now you’ve surely heard that Medicare is going to pay doctors and other qualified healthcare providers for advance care planning with patients in 2016.

Aren’t you excited?!?

Ok, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and chat about your future.

Maybe your Aunt Bertha did change your diapers when you were 6 months old, but do you really want her cleaning your feeding tube and wiping up your poop stains when you are 60? I mean heaven forbid that you end up in a chronically dependent or even vegetative state at such a youthful age, but what if…??? Did you even want to be kept alive in such a state at all…??? Certainly something to think about. Maybe you should give Aunt Bertha a call?

2. The loudest person in your family may not have your best interest in mind.

Oftentimes the loudest relative “runs the show” in the hospital- by guilt, intimidation, and a host of other aggressive or passive-aggressive strategies. If you don’t want “you-know-who” making decisions for you or bullying around your other relatives, while you lie helplessly in the hospital bed, then for Pete’s sake, choose and document your own healthcare proxy today! Make sure they know EXACTLY what’s acceptable and not for you.

3. I’ll bet you know who you DON’T want making decisions for you.

Simply put, some people can handle this kind of pressure and some people can’t. The people who would wilt under life and death decisions on your behalf should NOT become decision makers for you, either by intention or default.

4. Hell hath no fury like your family fighting over your fate or your fortune!

I’ve seen feuds break out around a deathbed that would make the Hatfields and the McCoys cringe. I always want to scream, “What the hell are you people doing? Can’t you see that your loved one is dying here?” (Of course that kind of outburst is never good for the physician professionalism scorecard, so I usually manage to translate the sentiment into something a bit more PC.) So, please, please I beg you to have your fate and your fortunes pre-determined before that fateful and inevitable moment arrives!

5. Grudges can come back to bite you.

One time the closest available relative to my unresponsive patient on full life support was his estranged wife. She had carried a grudge for 20 years. When we finally tracked her down to make a decision for my patient, with glee she whispered evilly, “Pull the plug.” (YIKES!) I’m pretty sure that guy would have had someone else in mind to make this decision, but IT WAS TOO LATE! No advance care plan was in place with his doctor. (I sense that you are getting my drift…)

6. No one knows your secret priorities.

During one of my traveling lecture series last year I met a gerontologist who shared some of the idiosyncrasies of his advance care plan with me. He had in writing, that should he become demented and placed in a nursing home: 1) Under no circumstances should he ever be physically or chemically restrained, and 2) He should be allowed to have sex with anyone who is willing to engage him

7. No one knows you like you… and you deserve a fitting exit.

I would like to die on a blanket under the oak tree at bottom of my field. My dad would like to be buried in a bright red racecar motif casket. My husband wants a Viking funeral pyre. I’m sure you have some pretty unique idea about your final goodbye as well… do you have the plan in place?

8. Embracing death will allow you to embrace life.

Is this too much for you? Think it’s too morbid? Let me tell you the great secret… when you embrace death in its inevitability, then each moment of life itself becomes more precious. Now will never come again. Planning for the end-of-life awakens you to the gift of this very moment of life, this very second. What a gift.

I love hospitalists, they are some of my favorite people. Like me, they come into the hospital and work their butts off for 10-12 hours with very little food or water. We are essentially kinfolk, and we take care of the same patients.

Because we are comrades, I make sure to meet and greet with hospitalists each time I see them. (Some of us even hug!)

One of my favorite hospitalist was in the ER today when I arrived, and somehow (of course) we got on the subject of advanced directives. He told me that his own living will says that when he cannot wipe his own ass, then doesn’t want to be kept alive by any medical interventions. (Excuse his “French”)

We both laughed knowingly.

He said that when he shared his living will with his wife, she freaked out. In her distress, she asked, “Don’t you love me? Don’t you love the children?”

He said, “Of course I do, however my definition of life meaning means being able to actually live.”

Pensively, I remarked, “We’ve seen too much haven’t we?”

We both nodded in agreement. Then, we both smiled and he admitted my next patient-an hundred-year-old man who could no longer wipe his own ass.

Recent articles suggest that doctors typically do not want aggressive measures for themselves at the end of their own lives.

I recently got back from an exciting vacation which included zip-lining and whitewater rafting. Repeatedly during this trip, my oldest daughter and I would encourage each other with the trendy term “#YOLO“-“you only live once,” before we did something that felt risky but adventurous. (No offense to my Hindu and Buddhist friends who might prefer another acronym such as “you only live as many times as you need to get it right”! #yolamtayntgir (Sorry…not terribly catchy guys!) Continue reading →

I sat in silence wrestling with myself, shifting in my seat, as my husband drove down the road. He pointed out some beautiful fall foliage. I looked at the trees but could not appreciate the scenery due to my turmoil. All I could think about was how uncomfortable I was with my father’s hospital discharge plan and how fractured end of life healthcare planning is in some states (specifically, states without a POLST form), states such as mine, Alabama. Since becoming active in advocating for better end of life healthcare planning, I have been a supporter of the POLST for lots of obvious reasons- but most basically, it ensures that the medical system obeys the wishes of the patient or the acting healthcare proxy. I have known abstractly how important such a document is for my patients. But now, a new personal knowledge is dawning for me—I now know firsthand how the LACK of a POLST or POLST-like document actually LIMITS healthcare options for those who are near the end of life! Continue reading →

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